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Pilot study comparing post-anesthesia care unit length of stay in moderately and severely obese children

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Obesity is a risk factor for surgical complications in adults and children. Differences in postsurgical outcomes according to severity of obesity [moderate: 95–98th age-gender-specific body mass index (BMI) percentile versus severe: ≥99th percentile] in children remain unclear. This study compared post-anesthesia care unit (PACU) stay and hospital admission between severely obese children and moderately obese children undergoing surgery.


In a retrospective review over a 6-month period, obese children, 2–18 years of age undergoing surgery were identified. Multivariate mixed-effects regression was used to compare PACU length of stay (LOS) need for opioid analgesia, and hospital admission between moderately and severely obese patients.


There were 1324 records selected for inclusion. PACU LOS did not significantly differ between moderately obese (50 ± 36 min) and severely obese patients (55 ± 38 min). There were no differences between moderately and severely obese patients in use of opioids in the PACU. Yet, severely obese patients were more likely to require inpatient admission than moderately obese patients.


The duration of PACU stay still averaged less than 1 h in our cohort, suggesting that the majority of these patients can be cared for safely in the outpatient setting. Future studies should focus on identifying the co-morbid conditions that may prolong postoperative PACU stay or result in unplanned hospital admission in moderately and severely obese patients. Our preliminary data suggest that these factors may include a younger age and the complexity or duration of the surgical procedure.

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  1. Skinner AC, Skelton JA. Prevalence and trends in obesity and severe obesity among children in the United States, 1999–2012. JAMA Pediatr. 2014;168:561–6.

    Article  PubMed  Google Scholar 

  2. Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States. JAMA. 2006;295:1549–55.

    Article  PubMed  Google Scholar 

  3. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents and adults. JAMA. 2004;291:2847–58.

    Article  CAS  PubMed  Google Scholar 

  4. Nafiu OO, Reynolds PI, Bamgbade OA, Tremper KK, Welch K, Kasa-Vubu JZ. Childhood body mass index and perioperative complications. Pediatr Anesth. 2007;17:426–30.

    Article  Google Scholar 

  5. Lavin JM, Shah RK. Postoperative complications in obese children undergoing adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 2015;79:1732–5.

    Article  PubMed  Google Scholar 

  6. Gleich SJ, Olson MD, Sprung J, Weingarten TN, Schroeder DR, Warner DO, Flick RP. Perioperative outcomes of severely obese children undergoing tonsillectomy. Paediatr Anaesth. 2012;22:1171–8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Collins CE, Everett LL. Challenges in pediatric ambulatory anesthesia: kids are different. Anesthesiol Clin. 2010;28:315–28.

    Article  PubMed  Google Scholar 

  8. Olutoye OA, Watcha MF, Andropoulos DB. Pediatric obesity: observed impact in the ambulatory surgery setting. J Natl Med Assoc. 2011;103:27–30.

    Article  PubMed  Google Scholar 

  9. Emhardt JD, Saysana C, Sirichotvithyakorn P. Anesthetic considerations for pediatric outpatient surgery. Semin Pediatr Surg. 2004;13:210–21.

    Article  PubMed  Google Scholar 

  10. Smith HL, Meldrum DJ, Brennan LJ. Childhood obesity: a challenge for the anesthetist? Paediatr Anesth. 2002;12:750–61.

    Article  CAS  Google Scholar 

  11. Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, Urbina EM, Ewing LJ, Daniels SR, American Heart Association Atherosclerosis, Hypertension, and Obesity in the Young Committee of the Council on Cardiovascular Disease in the Young, Council on Nutrition, Physical Activity and Metabolism, and Council on Clinical Cardiology. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association. Circulation. 2013;128:1689–712.

    Article  PubMed  Google Scholar 

  12. Cote CJ, Sheldon SH. Obstructive sleep apnea and tonsillectomy: do we have a new indication for extended postoperative observation? Can J Anaesth. 2004;51:6–12.

    Article  PubMed  Google Scholar 

  13. Nafiu OO, Green GE, Walton S, Morris M, Reddy S, Tremper KK. Obesity and risk of perioperative complications in children presenting for adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 2009;73:89–95.

    Article  PubMed  Google Scholar 

  14. Fung E, Cave D, Witmans M, Gan K, El-Hakim H. Postoperative respiratory complications and recovery in obese children following adenotonsillectomy for sleep-disordered breathing: a case-control study. Otolaryngol Head Neck Surg. 2010;142:898–905.

    Article  PubMed  Google Scholar 

  15. Liu FL, Cherng YG, Chen SY, Su YH, Huang SY, Lo PH, Lee YY, Tam KW. Postoperative recovery after anesthesia in morbidly obese patients: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2015;62:907–17.

    Article  PubMed  Google Scholar 

  16. Tait AR, Voepel-Lewis T, Burke C, Kostrzewa A, Lewis I. Incidence and risk factors for perioperative adverse respiratory events in children who are obese. Anesthesiology. 2008;108(375–80):17.

    Google Scholar 

  17. Sorof J, Daniels S. Obesity hypertension in children: a problem of epidemic proportions. Hypertension. 2002;40:441–7.

    Article  CAS  PubMed  Google Scholar 

  18. Barshop NJ, Francis CS, Schwimmer JB, Lavine JE. Nonalcoholic fatty liver disease as a comorbidity of childhood obesity. Pediatr Health. 2009;3:271–81.

    Article  Google Scholar 

  19. Malaty HM, Fraley JK, Abudayyeh S, Fairly KW, Javed US, Aboul-Fotouh H, Mattek N, Gilger MA. Obesity and gastroesophageal reflux disease and gastroesophageal reflux symptoms in children. Clin Exp Gastroenterol. 2009;2:31–6.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Raman VT, Jatana KR, Elmaraghy CA, Tobias JD. Guidelines to decrease unanticipated hospital admission following adenotonsillectomy in the pediatric population. Int J Pediatr Otorhinolaryngol. 2014;78:19–22.

    Article  PubMed  Google Scholar 

  21. AORN, Conner R, Blanchard JC. Perioperative standards and recommended practices. AORN. 2011.

  22. Gish EC, Harrison D, Gormley AK, Johnson PN. Dosing evaluation of continuous intravenous fentanyl infusions in overweight children: a pilot study. J Pediatr Pharmacol Ther. 2011;16:39–46.

    PubMed  PubMed Central  Google Scholar 

  23. Schwartz AE, Matteo RS, Ornstein E, Young WL, Myers KJ. Pharmacokinetics of sufentanil in obese patients. Anesth Analg. 1991;73:790–3.

    CAS  PubMed  Google Scholar 

  24. Shibutani K, Inchiosa MA Jr, Sawada K, Bairamian M. Pharmacokinetic mass of fentanyl for postoperative analgesia in lean and obese patients. Br J Anaesth. 2005;95:377–83.

    Article  CAS  PubMed  Google Scholar 

  25. Stucky ER, American Academy of Pediatric Committee on, Drugs; American Academy of Pediatrics Committee on Hospital Care. Prevention of medication errors in the pediatric inpatient setting. Pediatrics. 2003;112:431–6.

    Article  PubMed  Google Scholar 

  26. Dadure C, Macq C, Sola C, Raux O. Regional anesthesia for postoperative analgesia at home in children. Ann Fr Anesth Reanim. 2013;32:17–20.

    Article  Google Scholar 

  27. Schloss B, Bhalla T, Klingele K, Phillips D, Prestwich B, Tobias JD. A retrospective review of femoral nerve block for postoperative analgesia after knee surgery in the pediatric population. J Pediatr Orthop. 2014;34:459–61.

    Article  PubMed  Google Scholar 

  28. Khoury CE, Dagher C, Ghanem I, Naccache N, Jawish D, Yazbeck P. Combined regional and general anesthesia for ambulatory peripheral orthopedic surgery in children. J Pediatr Orthop B. 2009;18:37–45.

    Article  PubMed  Google Scholar 

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Correspondence to Hina Walia.

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This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Walia, H., Balaban, O., Jacklen, M. et al. Pilot study comparing post-anesthesia care unit length of stay in moderately and severely obese children. J Anesth 31, 510–516 (2017).

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